Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2020; 8(13): 2870-2875
Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2870
Posterior reversible encephalopathy syndrome and heart failure tacrolimus-induced after liver transplantation: A case report
Jun-Fang Liu, Tian Shen, Yun-Tao Zhang
Jun-Fang Liu, Tian Shen, Yun-Tao Zhang, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Liu JF, Shen T and Zhang YT treated the patient; Liu JF drafted the paper; all authors read and approved the final version to be published.
Informed consent statement: The participant, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest in this study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jun-Fang Liu, MD, Attending Doctor, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou 310003, Zhejiang Province, China. 1506087@zju.edu.com
Received: March 1, 2020
Peer-review started: March 2, 2020
First decision: April 7, 2020
Revised: May 7, 2020
Accepted: June 13, 2020
Article in press: June 13, 2020
Published online: July 6, 2020
Abstract
BACKGROUND

Patients undergoing liver transplantation can develop posterior reversible encephalopathy syndrome (PRES) and acute heart failure (HF) in the post-operative period. But PRES with HF caused by tacrolimus has rarely been described.

CASE SUMMAR

A 40-year-old female patient who had a normal preoperative cardiac and neural evaluation developed PRES with acute heart failure tacrolimus-induced after liver transplantation. The challenges associated with both diagnosis and management in the setting of a newly implanted graft are discussed.

CONCLUSION

Tacrolimus can induce neurotoxicity and then cardiac toxicity. Magnetic resonance imaging, echocardiography, and increased brain natriuretic peptide may be predictive of post-operative PRES with acute heart failure. Further investigations are necessary to verify this finding.

Keywords: Liver transplantation, Tacrolimus, Posterior reversible encephalopathy syndrome, Neurologic complications, Cardiac toxicity, Case report

Core tip: We describe a case of tacrolimus-induced posterior reversible encephalopathy syndrome with acute heart failure, which developed after liver transplantation in a patient who had a normal preoperative cardiac evaluation.